Functional neurological disorder following COVID-19 : results from a Large International Electronic Health Record Database

Berlot, Rok (author), Asan, Livia (author), Nicholson, Timothy R. (author), Stanton, Biba (author), Pollak, Thomas A. (author), Edwards, Mark J. (author)

Background: Following COVID-19, an increased risk of neurological and psychiatric sequelae has been reported. Viral illnesses commonly trigger functional neurological disorder (FND). However, mechanisms beyond immediate biological effects may contribute to FND after COVID-19. While FND cases have been observed after COVID-19, the overall risk and contributing factors remain unclear. In this retrospective cohort study, we compared the rates of FND post-COVID-19 to other respiratory tract infections (RTIs), assessed the influence of disease severity, and the characteristics of newly diagnosed patients. Methods: We used TriNetX, a global electronic health record network. In total, 2,740,094 COVID-19 cases and 1846 post-COVID-19 FND cases were analysed. We compared FND incidence between 2 weeks and 6 months after COVID-19 to other RTIs and across cohorts of varying COVID-19 severity. Characteristics of individuals with new diagnoses of FND and migraine following COVID-19 were compared. Results: The incidence of FND was higher in COVID-19 patients with records of hospitalisation (OR 2.165; 95% CI 1.691-2.773) and emergency department visits (OR 1.412; 95% CI 1.069-1.864). Incidence was higher following COVID-19 compared to other RTIs, both in the first 2 years of the pandemic (0.033 vs. 0.021%, OR 1.555, 95% CI 1.271-1.902) and subsequently (0.038 vs. 0.027%, OR 1.394, 95% CI 1.173-1.657). Medical, neurological, and psychiatric comorbidities were more common in newly diagnosed post-COVID-19 FND compared to migraine. Conclusions: New-onset FND appears more likely after COVID-19 than other RTIs. Both the severity of the triggering illness and pre-existing individual vulnerability may contribute to the development of FND.

• Language: English
• Keywords: COVID-19, conversion disorder, functional neurological disorder, neuropsychiatric manifestations, risk factors
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2025
• Number of pages: 10 str.
• Numbering: Vol. 32, iss .12
• PID: 20.500.12556/RUL-178403
• UDC: 616.8
• ISSN on article: 1468-1331
• DOI: 10.1111/ene.70459
• COBISS.SI-ID: 263346435
• Publication date in RUL: 27.01.2026

Record is a part of a journal

• Title: European journal of neurology
• Shortened title: Eur. j. neurol.
• Publisher: Wiley, European Academy of Neurology
• ISSN: 1468-1331
• COBISS.SI-ID: 23036377

Licences

• License: CC BY-NC 4.0, Creative Commons Attribution-NonCommercial 4.0 International
• Link: http://creativecommons.org/licenses/by-nc/4.0/
• Description: A creative commons license that bans commercial use, but the users don’t have to license their derivative works on the same terms.

Secondary language

• Language: Slovenian
• Keywords: konverzijska motnja, funkcionalna nevrološka motnja, nevropsihiatrične manifestacije, dejavniki tveganja

Projects

• Funder: ARIS - Slovenian Research and Innovation Agency
• Project number: P1-0389
• Name: Medicinska fizika

• Funder: DFG - German Research Foundation
• Funding programme: Clinician Scientist Programme
• Project number: FU356/12–UMEA